Medicare considers senior spy plan

Maryalene LaPonsie |
December 31, 2010

Cue the music and pull out the spy gear, Medicare is considering undercover operatives to conduct surveillance of health insurance companies. Maybe it's not Mission Impossible, but the Centers for Medicare & Medicaid Services (CMS) has issued a "sources sought notice" for mystery shopping services.

A search for deceptive health insurance company practices

The notice was posted on the CMS website to request information from companies that may be able to provide market surveillance of Medicare Advantage Organizations and Medicare Prescription Drug Programs. As Medicare programs have expanded, the widespread use of brokers to market plans has resulted in practices that "cause CMS considerable concern," according to a report in the trade publication National Underwriter Life & Health.

To combat unethical, and possibly illegal, marketing practices, CMS is now looking for vendors that can help the agency monitor Medicare promotional activity. The center already uses mystery shoppers to provide feedback on health insurance agents and Medicare hotline services. However, the new notice takes those activities a step further.

Their mission, should they be chosen to accept it

CMS is looking for vendors that can provide the following six services:

Mystery shopping for public marketing events of Medicare products

Year-round monitoring and surveillance of third party marketing sites and agents

Review of newspapers and other sources for unreported marketing events

Social media website monitoring

Information on Medicare marketing practices as they affect such vulnerable groups as disabled, low-income, low-education and non-English speaking populations

Monitoring of health insurance companies that choose to reduce or not renew the service area of their Medicare contracts

Protecting seniors from misleading health plans

The center will be taking vendor responses until mid-January 2011, and there is no guarantee that they will follow through and actually hire a mystery shopping company to complete this work. However, it is encouraging that Medicare officials are looking into the marketing practices of health insurance companies and independent agents.

With hundreds of plans from which to choose, competition is fierce. The estimated 47 million Medicare beneficiaries represent big business to many health insurance companies. And unfortunately, the Medicare system is complex and can be difficult to understand. Seniors trust that insurance agents will be honest about plan benefits, and sadly, some take advantage of that trust.

In November, CMS ordered three insurers to cease their Medicare marketing and enrollment activities. Universal American, Arcadian Health and Health Net were all targeted for engaging in misleading marketing campaigns and, in some cases, aggressive and abusive sales tactics. The suspension does not affect their ability to service their current subscriber bases, but the insurers will not be able to resume enrollment in the plans until they have demonstrated that they made necessary changes to their marketing and sales programs.

Protective steps for seniors to take

While CMS continues to work to protect seniors, no government program will ever be able to weed out all deceptive practices. Medicare beneficiaries should carefully review all paperwork before agreeing to a plan. Discuss any confusing details with a trusted friend or an adult child. And a good rule of thumb to remember is if you ever feel pressured to make a decision immediately, the right answer is usually, "no thank you."